700 NAI Consulting (Nickerson, L) 2021STATEMENT OF ECONOMIC INTEREST
COVER PAGE
A PUBLIC DOCUMENT
Please type or print in ink.
RECEIVED
CITY. OF LA QUINTA
NAME OF FILER (LAST) (FIRST) (MIDDLE) T
Nickerson, Jr. Lloyd
1. Office, Aqencv, or Court
Agency Name (Do not use acronyms)
City of La Quinta
Division, Board, Department, District, if applicable
Your Position
Contract Project Manager
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: —
2. Jurisdiction of Office (check at least one box)
❑ State
❑ Multi -County
0 City of La Quinta
3. Type of Statement (Check at least one box)
0 Annual: The period covered is January 1, 2021, through
December 31, 2021.
.or -
The period covered is I I
December 31, 2021.
❑ Assuming Office: Date assumed)
❑ Candidate: Date of Election
Schedule Summary (must complete)
Schedules attached
Position:
❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left I
(Check one circle.)
through ❑ The period covered is January 1, 2021, through the date of
leaving office.
.or -
El The period covered is I I through
the date of leaving office.
and office sought, if different than Part 1
► Total number of pages including this cover page: 3
❑ Schedule A-1 - Investments — schedule attached
■ Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
-or- ❑ None - No reportable interests on any schedule
5. Verification
FE-1 Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
68955 Adelina Road Cathedral City CA 92234
DAYTIME TELEPHONE NUMBER EMAILADDRESS
( 760 ) 323-5344 i nnickerson@naiconsulting.com
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
02/17/2022
(month, day, year) (File th originally vyned paper statement with your riling olkid )
FPPC Form 700 - Cover Page (2021/2022)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 5
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
mo. 1. BUSINESS ENTITY OR TRUST
NAI Consulting, Inc.
Name
68955 Adelina Road, Cathedral City, CA 92234
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
$0 - $1,999
$2,000 - $10,000 /21 /21
❑ $10-001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1.000,000
Q Over $1,000,000
NATURE OF INVESTMENT S-Corp
Partnership ❑ Sole Proprietorship ■I Other
YOUR BUSINESS POSITION President
SHARE OF •SS INCOME TO THE ENTITYITRUST)
[� $0 - $499 ❑ $1o,001 - $100,000
❑ $500 - $1,000 J OVER $100,000
❑ $1,001 - $1o,0o0
3. LIST THE NAME OF ••-TABLE SINGLE SOURCE OF
None or f] Names listed below
City of La Quinta
04. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST
Chccx one box'
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑k $2,000 - $10,000
❑ $10,001 - $100,000
❑❑ $100,001 - $1.000,000 ACQUIRED DISPOSED
Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
ll� 1. BUSINESS ENTITY OR TRUST
Name
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
$0 - $1,999
$2,000 - $10,000 21 --j--j21
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
❑ Over $1.000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑ Other
YOUR BUSINESS POSITION
SHARE OF •SS INCOME TO THE ENTITY/TRUST)
�❑ $0 - $499 ❑ $10,001 - $100,000
[D $500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
ll� 3. LIST THE NAME OF ••-TABLE SINGLE SOURCE OF
INCOMEOF $10,000 OR •
None or I f Names listed below
O1� 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD
LEASED BY THE BUSINESS ENTITY OR TRUST
R
one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
$2,000 - $10,000
$10,001 - $100,000 /21
$100,001 - $1,000,000 ACQUIRED DISPOSED
Over $1,000.000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
Comments:
FPPC Form 700 - Schedule A-2 (2021/2022)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 9
SCHEDULE C CALIFORNIA FORM
Income, Loans, & Business FAIR POLITICAL PRACTICES COMN
Positions Name
(Other than Gifts and Travel Payments) Lloyd Nickerson, Jr.
NAME OF SOURCE OF INCOME
NAI Consulting, Inc.
ADDRESS (Business Address Acceptable)
68955 Adelina Road, Cathedral City, CA 92234
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Civil Engineering Firm
YOUR BUSINESS POSITION
President
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 OVER $100,001)
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
0 Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
NAME OF SOURCE OF INCOME
California Department of Tax and Fee Administration
ADDRESS (Business Address Acceptable)
3737 Main St., Ste. 1000, Riverside, CA 92501
BUSINESS ACTIVITY, IF ANY, OF SOURCE
State Agency
YOUR BUSINESS POSITION
Spouse of Retired State Employee
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
p❑� $500 - $1,000 ❑ $1,001 - $10.000
LI $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
Other ■ Other Retirement Income
(Describe) � (Describe)
m� 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from a commercial lending institution, or any indebtedness created as part of
a retail installment or credit card transaction, made in the lender's regular course of business on terms available
to members of the public without regard to your official status. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1.001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
INTEREST RATE TERM (Months/Years)
% ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
❑ Guarantor
❑ Other
Street address
City
(Describe)
FPPC Form 700 - Schedule C (2021/2022)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page -13